Provider Demographics
NPI:1790827160
Name:THE NEW RIVER DENTAL CENTER, PC
Entity Type:Organization
Organization Name:THE NEW RIVER DENTAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT GUESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-208-2888
Mailing Address - Street 1:300 NEW RIVER PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-4450
Mailing Address - Country:US
Mailing Address - Phone:843-208-2888
Mailing Address - Fax:843-208-2882
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4450
Practice Address - Country:US
Practice Address - Phone:843-208-2888
Practice Address - Fax:888-239-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4081Medicaid